Bonica s Management of Pain, 4th Edition

Transcription

1 315 dedicated to assessment and diagnosis. These chapters initially contextualize the problem of cancer pain. Chapters 6 through 11 give detailed accounts of different cancer pain syndromes. The text is complemented by very well-selected imaging studies. The second section includes 14 chapters dedicated to issues of management. Again, the first two chapters contextualize the section, presenting an overview of management and discussion of the comprehensive care of the cancer patient with pain. Remarkably, although neither author trained in oncology, they give excellent up-todate and very well-referenced accounts of common malignancies, their treatment, and antitumor approaches to relieve pain in cancer patients. Chapters 16 through 20 present detailed accounts of pharmacotherapy for cancer pain, including a very useful and balanced discussion of potential problems of misuse and abuse associated with opioid therapy. As would be anticipated in a text offered by specialists in anesthesiology and neurosurgery, interventional and spinal approaches are well covered. To their credit, the overall balance of approaches is extremely sound. The final section of the book includes 14 appendices presenting a range of forms and evaluation tools that are widely used and often helpful. One notable absence is that of the Brief Pain Inventory (or a similar multidimensional assessment form), given its widespread use and value in clinical practice and research. The strength of the text is that it is generally well presented, extremely current, and very well referenced. With so much to praise, what are the shortcomings of this volume? In the context of so broad an endeavor, my criticisms are relatively few. The text pays very scant attention to the problem of refractory pain and to the logistics of providing sedation as an option of last resort in this context. Similarly, there is little specific attention given to incident or breakthrough pain and the various strategies that may be appropriate for this very common and challenging problem among patients with cancer. The therapeutic modalities of rehabilitation and psychological care as part of an overall pain management strategy receive little attention. Finally, the text does not address issues related to cancer pain in children. Should they be so brave and industrious, I would hope that these shortcomings could be addressed by the authors in subsequent editions. This book would be an excellent choice for clinicians seeking a well-presented and current text about cancer pain in adults, priced at about $ through the usual online outlets. However, for readers with a larger budget who are seeking a more comprehensive text that also addresses cancer pain in children and a more detailed account of some of the areas identified as deficient in this volume, I would direct them to other options, specifically Cancer Pain: Assessment and Management, 2nd edition, edited by Bruera and Portenoy and published by Cambridge University Press ($ at Amazon.com), or to the new fourth edition of the Oxford Textbook of Palliative Medicine ($ at Amazon.com). Conflict of Interest Disclosure: The author of this review is an editor of the Oxford Textbook of Palliative Medicine. doi: /j.jpainsymman Bonica s Management of Pain, 4th Edition C. Peter N. Watson, MD, FRCPC Bonica s Management of Pain, 4th Edition (with access to complete contents online) Edited by Scott M. Fishman, Jane C. Ballantyne, and James P. Rathmell Published by Lippincott, Williams and Wilkins, Philadelphia, PA, USA 2010, 1661 pages, $ (Hardcover) The fourth edition of this well-respected reference book has had an almost complete change of section editors and authorship. The C. Peter N. Watson, MD, FRCP, is Assistant Professor, Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.

2 316 Book Reviews Vol. 40 No. 2 August 2010 four editions have evolved from the almost exclusive work of John Bonica in The second edition, published 30 years later, was again from Dr. Bonica, with contributors for more than half the book; and the third edition in 2001, edited by John Loeser et al., extensively expanded the content related to basic science and clinical pain management. In this edition, the editors aim to keep the book to its original manageable size with a shift in the book s emphasis from peripheral (anatomically based) mechanisms to one with a greater focus on neural (global) mechanisms. New or updated chapters focus on issues that impact clinical pain management, such as pain training, regulatory and political issues, and conducting clinical trials. Their stated goal is to remain faithful to Bonica s original intent to provide a comprehensive reference for practicing clinicians across all disciplines. They state that every chapter has been substantially rewritten or is completely new. The book is divided into six parts: I. Basic Considerations; II. Economic, Political, Legal, and Ethical Considerations; III. Evaluation of the Pain Patient; IV. Pain Conditions; V. Methods for Symptomatic Control; and VI. Provisions of Pain Treatment. Part II represents new content reflecting the emerging social impact of pain and pain management. The preface concludes by stating, Like Bonica our central purpose is to assist students and practitioners across all medical disciplines, advance their knowledge of pain medicine, and relieve suffering. Part I. Basic Considerations begins with an account of intellectual milestones in pain and is accompanied by portraits of many well-known historical figures, including several individuals who are known to many of us in this field, for example, early photographs of Ronald Melzack and Patrick Wall at the time of their initial collaboration and John Bonica, Harold Merskey, and Clifford Woolf. Chapter 2 focuses on pain terms and taxonomies, including a useful list of definitions, many of which are from the International Association for the Study of Pain (IASP) Taxonomy. A concept of acute and chronic pain is proposed based on time and physical pathology. However, the reader may question whether, as suggested, chronic cancer pain can be related to this because the model implies low pathology with chronic pain. The reader also may challenge whether the recurrent pains of migraine, trigeminal neuralgia, and sickle cell disease involve major components of psychosocial and behavioral factors. The definitions from the IASP Taxonomy are usefully indicated by an asterisk. Neuropathic pain is defined according to recent suggestions for change and excludes the term dysfunction, with some other changes. The reader needs to be cautioned that these changes have not been accepted by the IASP. There is an exhaustive discussion of taxonomies of pain including the IASP Taxonomy, which is criticized because it excludes the assessment of psychosocial and behavioral data and has not been repeatedly evaluated in terms of reliability, validity, and utility. Chapters 3 through 7 logically progress from peripheral pain mechanisms through spinal cord nociceptive processing and its modulation, supraspinal mechanisms, and psychological aspects of pain. Chapters 8 and 9 discuss individual differences and functional anatomy. The section finishes with a useful chapter on clinical trials. Part II is new, with five chapters, and is entitled Economic, Political, Legal, and Ethical Considerations and begins with a chapter on sociocultural dimensions of pain management. This excellent chapter will be of interest to the general readership and is, in my opinion, a pillar of the book. It is of relevance to both the basic scientist and those in the trenches. The linking of chronic pain to belief, culture, and social practice is exactly what an evidence-based molecular gaze cannot ignore. The conclusion is that there is no magic bullet and that chronic pain cannot be reduced to a diagram of cellular processes but that cellular processes are open to modification. The authors suggest that personal, social, and cultural factors make it one of the most difficult challenges that pain medicine in the 21st century needs to address effectively. Another chapter on ethical issues concludes that the ethics of pain management is in a profound state of flux. These authors discuss chronic noncancer pain in terms of issues, such as opioid contracts, drug screening, and the issue of trust. The contentious issue of opioids for chronic noncancer pain is highlighted, contrasting the World Health Organization and the IASPdboth calling for the recognition of pain relief for all patientsdwith other statements of dire warnings to clinicians about deceptive drug-seeking patients who must be engaged with extreme caution, robust

3 317 skepticism and vigorous scrutiny as well as pharmacovigilance. The increasing number of clinicians engaged in the prescription of opioids for chronic noncancer pain will find this chapter particularly valuable. Following also are chapters on ethical issues in the care of dying patients, laws and policies affecting pain management, and litigation involving pain management. Finally, in this section, there is an authoritative and comprehensive chapter on opioid policy and the availability and access in developing and nonindustrial countries by David Joranson et al. I was pleased to see a total of five chapters dealing with current issues surrounding opioid use and substance abuse. As well, these highly pertinent subjects are covered in parts of other chapters. Part III has all new authors and deals with the evaluation of the pain patient. This section retains the same chapter headings as in the previous volume with two exceptions. A comprehensive chapter on the medical evaluation of the chronic pain patient refers to various outcome measures that can be used both in the office and for research. Additional chapters discuss the electrodiagnostic evaluation of pain syndromes, diagnostic imaging and measurement of pain, psychosocial evaluation, disability evaluation of painful conditions, and multidisciplinary assessment of patients with chronic pain. All these are worthy successors to the chapters found in the previous volume. Part IV is a critical part of this book dealing with various pain conditions. Separate sections are included on neuropathic pain; psychological contributions; vascular, cutaneous, and musculoskeletal pains; cancer pain; and acute pain. A new chapter focuses on pain and special populations, such as patients with a history of substance abuse. The chapters on visceral pain, headache, chest, abdominal and pelvic pain, regional pains in the head, neck, arm, chest, and lower extremity and low back pain are important and comprehensive. With regard to neuropathic pain, these authors are well-known authorities on specific syndromes, including neuropathies, complex regional pain syndrome, phantom pain, pain with herpes zoster, and central pain. The psychological contributions appear authoritative, and a chapter on the psychology of addiction is included, adding to this important focus of the book. The section on pain because of cancer deals with specific issues in this regard and appears very comprehensive. The section on regional pain affecting the neck and arm includes a discussion of Waddell s nonanatomical signs and emphasizes that these are signs (as Waddell described initially) of significant psychosocial stress and not indicative of signs of malingering or secondary gain. The illustrations in this section, and really throughout this book, are particularly clear and attractive. The low back pain section is also of particular importance and includes contributions by Nikolai Bogduk et al. Dr. Bogduk expands and reprises his important assessment points here as in a recent review (Pain 2009;147:17e19). Either should be considered required reading for all specialists dealing with chronic back and leg pain patients. Part V contains six sections on pharmacologic, psychological, physical, and various interventional and surgical approaches for the control of pain. The pharmacologic therapies section begins with an excellent introductory chapter on rational pharmacotherapy, emphasizing that drugs are probably overused and should be combined with other modalities. The chapter on nonsteroidal anti-inflammatory drugs and acetaminophen is comprehensive. The chapters pertaining to opioid analgesics and substance abuse should be considered mandatory for all clinicians who treat patients with pain. The final two chapters include skeletal muscle relaxants and topical agents and a thorough chapter on neuropathic pain pharmacotherapy. The psychological technique section deals with important issues, including anger and pain, cognitive behavioral therapy, pain and its relationship to anxiety and depression, hypnosis, relaxation therapy, and group therapy. The final chapter is on motivating pain patients for behavioral change. All these are critical and perhaps overlooked approaches essential for a multidisciplinary approach, which is also a running theme of this book. The section on physical and other noninterventional therapeutics has been expanded and retains only one previous chapter on basic concepts and biomechanics in musculoskeletal rehabilitation. An important chapter is on the assessment and treatment of chemical dependency. The three chapters on implanted electrical stimulators are comprehensive and authoritative. Interventional pain management includes

4 318 Book Reviews Vol. 40 No. 2 August 2010 nerve blocks, epidural steroids, intrathecal drug delivery, intradiscal therapies for low back pain, and neurolytic blockade for noncancer pain. The authorship, including Nikolai Bogduk et al., ensures the high quality of this section. There is an emphasis here on the importance of selecting patients carefully, the possible complications of these procedures, and the lack of a substantial evidence base supporting these treatments. These sections are very useful for the nonsurgeon and the interventionalist. The discussion of nerve blocks emphasizes that a positive response to a somatic or sympathetic nerve block should not be assumed to be predictive of a favorable outcome to treatment, such as ablative procedures. Because the long-held view of the value of prognostic use of blocks seems to persist, this is an important and insightful contribution. The chapter concludes with a challenge to experts in this discipline to provide greater validity for the use of nerve blocks. The chapter on epidural steroids is thorough and cautions that although some observational studies have reported short-term success over 20 to 30 days, long-term controlled trials have shown no attributable effect. The author concludes that it may be that it is the injection rather than what is injected that may be the reason the treatment appears to work. A thorough chapter on intrathecal drug delivery concludes that this is a viable option for patients with intractable pain that cannot be managed by other means. Although the procedure itself is relatively simple, the authors emphasize that the management of these patients is far from simple, particularly for noncancer pain conditions. Multiple issues can develop during the course of treatment and, therefore, the treatment should not be entered into lightly. The importance of judicious patient selection, meticulous surgical technique, and diligent patient management is emphasized. Intrathecal disc therapy is a practical chapter that points out that preventing or treating disc degeneration may have limited clinical relevance. Disc changes are found in most asymptomatic adults, and clinical correlation of the symptom complex with the radiological abnormalities is highlighted. The authors point out that although there is the potential of regenerative approaches, their ultimate role is unclear. Neurolytic blockade for chronic noncancer pain is thoroughly covered and cautions regarding the lack of placebo-controlled trials and the difficulties of conducting them but makes a strong case for good observational data in this area. The final section of Part V describes surgical approaches to pain. The chapter on surgery of the peripheral nervous system is comprehensive and has been contributed by James Campbell et al. The chapter includes peripheral neurectomy, nerve entrapment release procedures, dorsal rhizotomy and ganglionectomy, and sympathectomy. It emphasizes the importance of careful patient selection and clear establishment of the etiology of the pain condition and surgical technique as critical to ensure successful analgesia. It is emphasized that enthusiasm for these procedures must be tempered by a keen appreciation of potential complications, particularly the possibility of anesthesia dolorosa with nerve transection. The importance of the release of nerve root entrapment is appropriate, and less common entrapments than carpal tunnel and ulnar nerve entrapment may be overlooked or misdiagnosed. The appropriately infrequent use of dorsal rhizotomy and ganglionectomy and also sympathectomy only in refractory patients is cautionary. The surgical management of trigeminal neuralgia chapter is practical, emphasizing the preferred potentially curative operation of microvascular decompression except in elderly patients with significant comorbidities, where percutaneous procedures and radiosurgery may be more appropriate. The discussion of drug therapies for trigeminal neuralgia is succinct and also available in more detail elsewhere in the book (under Cranial Neuralgias). A chapter on the various ablative neurosurgical procedures for chronic pain completes this section and points out that these procedures have been largely replaced in developed countries by improved pharmacotherapy, intrathecal delivery systems, and high frequency stimulation techniques in patients without contraindication because of underlying medical conditions. Part VI focuses on pain treatment delivery and begins with an interesting discussion of the rise and fall of interdisciplinary chronic pain management, with a perspective on the history, current status, and future viability.

5 319 Issues around the reduction in the once abundant programs in the United States are discussed in detail. The specific issue of spine clinics and their utility comprises a second chapter. An important chapter on pain management and primary care focuses on how developing a patient treatment plan and mutually agreed on goals allows the physician to conduct a follow-up visit in 15 minutes. One chapter provides a thorough discussion of pain management at the end of life and expresses the need for a well-functioning interdisciplinary team combining the expertise of each individual to provide optimal care to this vulnerable group. A discussion of palliative sedation is presented here. A chapter on training pain specialists, authored by four authoritiesinthisarea,describesthechallenges and future of training. Chapters on dealing with emergencies in the pain clinic, pain management in the intensive care unit, and pain management in the emergency department will be of great interest to specific readers. A final chapter is a brief epilogue on the future of pain medicine. In summary, I highly recommend this book to clinicians and clinical and basic scientists involved with the problems of acute and/or chronic pain. It is a most worthy successor to the superb first two editions edited by John Bonica and the excellent third edited by John Loeser. It is an encyclopedic but easily readable reference book. The illustrations are of particular value. This book is authoritative and comprehensive, emphasizing multidisciplinary and multimodel approaches to managing pain, all significant components of which are found within its pages. doi: /j.jpainsymman